Prevalence and risk factors of chronic obstructive pulmonary disease in China (the China Pulmonary Health [CPH] study): a national cross-sectional study.
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Wang Chen, Xu Jianying, Yang Lan, Xu Yongjian, Zhang Xiangyan, Bai Chunxue, Kang Jian, Ran Pixin, Shen Huahao, Wen Fuqiang, Huang Kewu, Yao Wanzhen, Sun Tieying, Shan Guangliang, Yang Ting, Lin Yingxiang, Wu Sinan, Zhu Jianguo, Wang Ruiying, Shi Zhihong, Zhao Jianping, Ye Xianwei, Song Yuanlin, Wang Qiuyue, Zhou Yumin, Ding Liren, Yang Ting, Chen Yahong, Guo Yanfei, Xiao Fei, Lu Yong, Peng Xiaoxia, Zhang Biao, Xiao Dan, Chen Chung-Shiuan, Wang Zuomin, Zhang Hong, Bu Xiaoning, Zhang Xiaolei, An Li, Zhang Shu, Cao Zhixin, Zhan Qingyuan, Yang Yuanhua, Cao Bin, Dai Huaping, Liang Lirong, He Jiang, China Pulmonary Health Study Group
Аннотация
METHODS: The CPH study is a cross-sectional study in a nationally representative sample of adults aged 20 years or older from ten provinces, autonomous regions, and municipalities in mainland China. All participants underwent a post-bronchodilator pulmonary function test. COPD was diagnosed according to 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria.
FINDINGS: Between June, 2012, and May, 2015, 57 779 individuals were invited to participate, of whom 50 991 (21 446 men and 29 545 women) had reliable post-bronchodilator results and were included in the final analysis. The overall prevalence of spirometry-defined COPD was 8·6% (95% CI 7·5-9·9), accounting for 99·9 (95% CI 76·3-135·7) million people with COPD in China. Prevalence was higher in men (11·9%, 95% CI 10·2-13·8) than in women (5·4%, 4·6-6·2; p<0·0001 for sex difference) and in people aged 40 years or older (13·7%, 12·1-15·5) than in those aged 20-39 years (2·1%, 1·4-3·2; p<0·0001 for age difference). Only 12·0% (95% CI 8·1-17·4) of people with COPD reported a previous pulmonary function test. Risk factors for COPD included smoking exposure of 20 pack-years or more (odds ratio [OR] 1·95, 95% CI 1·53-2·47), exposure to annual mean particulate matter with a diameter less than 2·5 μm of 50-74 μg/m3 (1·85, 1·23-2·77) or 75 μg/m3 or higher (2·00, 1·36-2·92), underweight (body-mass index <18·5 kg/m2; 1·43, 1·03-1·97), sometimes childhood chronic cough (1·48, 1·14-1·93) or frequent cough (2·57, 2·01-3·29), and parental history of respiratory diseases (1·40, 1·23-1·60). A lower risk of COPD was associated with middle or high school education (OR 0·76, 95% CI 0·64-0·90) and college or higher education (0·47, 0·33-0·66).
INTERPRETATION: Spirometry-defined COPD is highly prevalent in the Chinese adult population. Cigarette smoking, ambient air pollution, underweight, childhood chronic cough, parental history of respiratory diseases, and low education are major risk factors for COPD. Prevention and early detection of COPD using spirometry should be a public health priority in China to reduce COPD-related morbidity and mortality.
FUNDING: Ministry of Health and Ministry of Science and Technology of China.